Dysgraphia

Generality

Dysgraphia is a specific learning disorder which, in the bearer, causes numerous problems in the writing of letters and numbers.
These are typical problems of those suffering from dysgraphia: the difficulty in holding a pen or pencil, the inability to respect the lines present in the notebooks, the tendency to make spelling errors, etc.

Like other specific learning disorders (dyslexia, dyscalculia, etc.), dysgraphia is an innate and permanent disability, which generally emerges shortly before or immediately after the start of elementary school.
Most likely, the onset of dysgraphia is linked to a deficit in the so-called working memory.
Today, dysgraphia sufferers can count on a support program for the specific enhancement of writing skills.

What is dysgraphia?

Dysgraphia is a specific learning disorder which, in the carrier, causes difficulties in writing and in the graphic reproduction of alphanumeric characters.
The dysgrapher - that is, those who suffer from dysgraphia - have problems holding a pen or a pencil, cannot align the letters of a word or a phrase, writes in a very disordered way, commits numerous spelling errors and, finally, is unable to report his thoughts in clear and organized written language.
Typically, dysgraphia is a problem that emerges at a young age - either shortly before the school years or early school years - and is maintained throughout life.

ORIGIN OF THE NAME

The word "dysgraphia" comes from the Greek and is, to be precise, the result of the "union of the pejorative prefix" dis "(δυσ) with the word" handwriting "(γραϕία), which means" writing ".
Literally, dysgraphia means "bad writing".

IS IT AN INNATE DISORDER?

Doctors and experts believe that dysgraphia is an innate condition.
In other words, the individual with dysgraphia would be born with a low propensity for written expression.

DEFINITION ACCORDING TO THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

Premise: the Diagnostic and Statistical Manual of Mental Disorders (abbreviated to DSM) is a collection of all the peculiar characteristics of known psychic and mental illnesses, including the respective criteria required for diagnosis.
The doctors and psychologists who wrote the latest edition (V) of the DSM felt that it was more correct to identify dysgraphia with a different wording, namely: written expression disorder.
Anyone wishing to consult the aforementioned text, to understand dysgraphia in detail, must take this change of name into account.

IS IT SYNONYMOUS WITH AGRAPHY?

Dysgraphia and agraphia are two slightly different problems, therefore those who use the two terms indiscriminately make a mistake.
Hagraphy is an acquired disorder characterized by the complete loss of writing skills resulting from a brain injury, stroke, or progressive neurological disease.

EPIDEMIOLOGY

The exact incidence of dysgraphia in the general population is unknown.
However, according to the results of the most recent surveys, this particular learning disorder, which affects written expression, would be more common than is believed.
For reasons still unknown, dysgraphia is a problem found with a frequency higher than normal in subjects with: dyslexia, ADHD (ie attention deficit hyperactivity disorder) or dyspraxia.

LEARNING DISORDERS: WHAT ARE THEY?

The specific learning disorders are disabilities (not diseases!) Which, in those who carry them, are the cause of obvious problems in reading, writing and calculating.
In addition to dysgraphia, the aforementioned dyslexia, dyscalculia and dysorthography are among the learning disorders.

Classification

Physicians and experts in specific learning disorders believe that there are three different subtypes of dysgraphia: dyslexic dysgraphia, motor dysgraphia and spatial dysgraphia.

Main features of dyslexic dysgraphia:

• spontaneous writing of texts is illegible, particularly if the text is complex;
• the ability to write orally dictated texts is very poor;
• drawing and copying of written texts are relatively normal;
• the speed of fine motor movements (fine motor skills) is normal.

Main features of motor dysgraphia:

• spontaneous writing and copying of texts are not legible;
• the ability to write from dictation may be normal;
• the drawing is somewhat problematic;
• fine motor movements are difficult.

Main features of spatial dysgraphia:

• the handwriting is illegible in all writings (spontaneous and copied);
• oral spelling is normal;
• drawing is very problematic.

Causes

The precise causes of dysgraphia remain, for now, a mystery.
According to the most reliable studies, a deficit of the so-called working memory plays a fundamental role, a deficit due to which an individual is unable to remember and make his own the sequence of movements necessary for writing letters and numbers.
In simpler words, experts believe that dysgraphic subjects lack the brain capacity that allows them to memorize movements for writing, in such a way as to reproduce them without problems, automatically.
Recently, some research has brought to light a possible correlation between dysgraphia and a "genetic alteration (mutation) affecting chromosome 6. This discovery still presents several question marks, which deserve proper investigation.

Symptoms and Complications

See also: Symptoms Dysgraphia

Dysgraphia causes a number of symptoms and signs, which, for convenience of reference, experts group into 6 categories:

• Category 1: visual-spatial difficulties. This category includes:
• Difficulty recognizing the shape of similar alphanumeric characters and deciphering the spacing between letters.
• The difficulty in organizing and planning words on the page from left to right.
• The tendency to write letters in every direction.
• The tendency not to separate the various words. So, on the page, there is in fact a very long sequence of letters.
• The difficulty in respecting the lines of writing on the pages or in staying within the margins.
• Difficulty reading / deciphering maps or drawings.
• The difficulty in reproducing certain forms.
• An evident slowness in copying a written text.
• Category 2: difficulties related to fine motor skills. This category includes:
• Difficulty holding a pencil or pen correctly, using cutlery properly (especially the knife), tying your shoes, writing an SMS and / or typing keyboard buttons.
• The difficulty in using scissors properly.
• The inability to color a figure without going beyond the margins.
• The tendency to hold the hand, wrist and / or arm in an awkward position while writing. This can lead to the onset of cramps in the aforementioned anatomical areas.
• Category 3: problems related to language processing. This category includes:
• The difficulty in writing down ideas and thoughts.
• The difficulty in understanding the rules of a game.
• The difficulty in following the instructions given.
• The tendency to lose the train of thought.
• Category 4: Spelling and handwriting problems. This category includes:
• The difficulty in understanding and mastering the spelling rules.
• The difficulty in identifying the misspelled words.
• The tendency to make spelling mistakes, in spite of correct oral language.
• The tendency to spell words incorrectly and in many different ways.
• The tendency to incorrectly check spelling.
• The tendency to mix uppercase and lowercase letters.
• The tendency to mix italics with block letters.
• The difficulty in reading one's own writing.
• The preference not to write, in order to avoid embarrassment.
• The tendency to erase written words.
• The tendency to get tired easily when writing even a very short text.
• Category 5: grammar problems. This category includes:
• Difficulty in using punctuation correctly.
• The tendency to insert commas even where not necessary (overuse of commas).
• The difficulty in using the right tense.
• The tendency not to use capital letters at the beginning of a sentence and after a period.
• The difficulty in writing complete sentences and the preference for writing in list format.
• Category 6: problems related to the organization of written language. This category includes:
• The difficulty of telling a story from the beginning.
• During the telling of a story, the tendency to leave out important facts or notions and to tell, instead, superfluous events.
• The tendency not to make explicit the topic of discussion, with the idea that others can intuit it from certain references.
• The tendency to describe facts, events or circumstances in a very vague way.
• The tendency to write confusing sentences.
• The tendency to never "get to the point" of the situation or the tendency to get there repeatedly, reiterating the final concept.
• The tendency to better express one's ideas and thoughts through oral language.

  

WHEN DO THE FIRST EVENTS APPEAR?

Typically, an individual with dysgraphia shows the first problems of disability when they start writing, then towards the age of kindergarten or elementary school.

• In preschool age, patients show some reluctance to write and draw. Moreover, compared to their peers, they do not like drawing at all.
• In elementary school age, patients tend to: write illegibly; mix italics with block letters; do not keep to the writing lines of notebooks; write by continuously varying the size of the letters; read aloud when writing; finally, encountering numerous difficulties in "expressing oneself with written language.
• In adolescence, patients only write simple sentences, as sentences with subordinates are problematic. In addition, they make numerous grammatical errors, far more than those made by an equal age.

CONSEQUENCES ON THE PSYCHO-EMOTIONAL SPHERE

Suffering from dysgraphia can also have various consequences on the psycho-emotional sphere.
In fact, people with this disability are aware of their own difficulties and, feeling "different" from their peers, tend to isolate themselves socially and develop low self-esteem, low self-efficacy, sense of inferiority, anxiety attacks, frustration (because, despite efforts do not get the desired results) and depression (in severe cases).

HOW DYSGRAPHY AFFECTS THE DEVELOPMENT OF A CHILD

The impact of dysgraphia on a child's development can be substantial.
In fact, this disability can affect:

• Academic growth. As a result of their reduced writing skills, young people with dysgraphia are particularly slow in school work: they cannot meet the deadlines for class assignments, they take a long time to do their homework, they cannot take notes, etc.
• The skills and abilities required in everyday life. Often, children with dysgraphia have motor problems, which prevent them from carrying out very simple daily gestures such as: buttoning a jacket or shirt, compiling a trivial list of things, etc.
• The socio-emotional sphere. As mentioned, dysgraphia causes social isolation, low self-esteem, a sense of inferiority, frustration, etc.

DYSGRAPHY DOES NOT MEAN LACK OF INTELLECT

Contrary to what many believe, dysgraphia is not an expression of a reduced intellectual capacity or even of laziness.
Individuals with dysgraphia, in fact, are subjects with an average "intelligence, who can have the same success in school and at work as a person who is not affected by any specific learning disorder.

CONDITIONS ASSOCIATED WITH DYSGRAPHY

For reasons still unknown, dyscalculia is associated with: dyslexia, attention deficit hyperactivity disorder (ADHD), dyspraxia or specific language disorders.
At the present time, doctors and experts in the field of dysgraphia are trying to understand if there is a link between the latter and the appearance of the aforementioned associated problems.

Diagnosis

Generally, the diagnostic process for the detection of dysgraphia involves a team of professionals (including doctors, speech therapists, psychiatrists, psychologists and experts in learning disorders) and includes a series of assessment tests that measure:

• The skills of written expression.
• Fine motor skills.
• The impact of dysgraphia on academic growth and the socio-emotional sphere.

WHAT DO THE EVALUATION TESTS CONSIST OF?

Evaluation tests for diagnosing dysgraphia include:

• Tests of writing and copying a text.
• The observation of the posture and position taken by the patient while writing.
• Observing how the patient holds the pen or pencil.
• Observing how tiring it is for the patient to engage in writing exercises (hand cramps, arm pains, etc.).
• The observation of the writing speed.
• The observation of how much the patient is scholastically affected by his disability.
• The observation of how much the patient is emotionally and socially affected by his disability.

TYPICAL AGE OF DIAGNOSIS

In most cases, dysgraphia clearly emerges around the years of the third grade (9 years). Therefore, in general, the diagnosis is made at this age.

Support tools

Premise: Dysgraphia, like other specific learning disorders, is a permanent disability and not a disease. Therefore, talking about therapies or treatment techniques is inaccurate and could lead some readers to believe that healing is possible.
In other words, an individual with dysgraphia will never acquire the writing skills of a healthy person.

Today, individuals with dysgraphia can count on a support program with a dual objective: the enhancement of writing skills and the recovery, as far as possible, of the so-called basic automatisms (i.e. sight-movement coordination, space-time organization, muscle relaxation , balance, etc.).
From a practical point of view, the support program envisaged in the case of dysgraphia includes: exercises for the improvement of basic automatisms and the use of so-called compensatory tools and methods ("compensatory" because they compensate for the patient's shortcomings).

IMPROVEMENT OF BASIC AUTOMATISMS

The improvement of basic automatisms includes exercises aimed at strengthening hand-eye coordination, muscle strength, dexterity in holding objects such as pens or pencils, balance, space-time organization, etc.
The task of subjecting the patient to such exercises rests with therapists specialized in the field of specific learning disorders.

COMPENSATIVE TOOLS AND METHODS

Compensatory tools and methods for dysgraphia include: electronic writing tools, special notebooks and changes in school workload.
Electronic writing tools make it easier for you to do classwork and collect notes in class.
The special notebooks are notebooks that have writing spaces delimited by colored lines (usually blue or yellow), in such a way as to facilitate the spatial organization of a text written on the white pages. Among the special notebooks, the most used are the so-called Erickson notebooks.
Finally, the changes in the school workload essentially consist in the granting of being able to write shorter texts and answer fewer questions, during class exercises.
To describe compensatory tools and methods (and their purpose) by comparison, experts in dysgraphia and other specific "learning disorders" tend to define them "like spectacles for a nearsighted person."
In Italy, the use of compensatory instruments, as support for people with dysgraphia, is also required by law (to be precise, law 170/2010).

Important note!
Some might think that the compensatory tools facilitate the scholastic path of subjects with dysgraphia, making the study load less onerous.
However, it should be noted that this is not the case at all: in the school environment, compensatory instruments do not represent either a facilitation or an advantage, therefore any criticism of their use is superfluous.

ADVICE FOR PARENTS

The contribution that parents can make to enhancing the writing skills of their child with dysgraphia is essential.
Generally, experts advise fathers and mothers of dysgraphic children to:

• Observe and take note of your loved one's writing difficulties. Each patient with dysgraphia is a case in itself and, for therapists, knowing what the patient's exact difficulties are makes it easier to plan the support program.
• Get your loved one used to some simple warm-up exercises. The purpose of these exercises is to reduce the stress and anxiety that writing can cause to the detriment of a dysgraphic subject.
• Have your loved one play games aimed at strengthening motor skills. Through these games, the patient strengthens the hand muscles and increases sight-movement (or visuo-motor) coordination skills.

Prognosis

For a permanent disability such as dysgraphia, discussing a positive prognosis may be inappropriate.
However, it should be noted that the path of strengthening letter and number writing skills is all the more effective, the sooner it begins.
In other words, a patient with dysgraphia who relies early on supportive strategies derives more benefits from them than a patient with dysgraphia who delays the onset of enhancement.